Surgical management of intracranial arachnoid cysts in pediatric patients: radiological and clinical outcome

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  • 1 Pediatric Neurosurgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin;
  • 2 QUEST Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin; and
  • 3 Department of Neuroradiology, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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OBJECTIVE

Congenital intracranial cysts account for a significant portion of intracranial lesions in the pediatric population. The efficiency of surgical treatment in a pediatric cohort with intracranial arachnoid cysts (ACs) at different locations regarding clinical symptoms and mass effect was evaluated.

METHODS

A retrospective study of all children who underwent surgical treatment of an intracranial AC during an 11-year period (2007–2018) was performed. Demographics, clinical symptoms, and radiological cyst size pre- and postoperatively, as well as the reoperation rate and possible treatment complications, were analyzed.

RESULTS

A total of 116 intracranial cysts at 8 different anatomical locations were surgically treated in 113 children (median age 5 years and 10 months) predominantly by endoscopic technique (84%). The complication rate was 3%, and the reoperation rate was 16%. Preoperative cyst enlargement was significantly more common in infants (p < 0.0001), as was the need for reoperation (p = 0.023). After a median radiological follow-up of 26 months, > 50% reduction of cyst volume was seen in 53 cysts (46%), and 47 cysts (40%) showed a 10%–50% reduction. Acute clinical symptoms improved: nausea and vomiting, accelerated head growth, and headaches improved at 100%, 92% and 89%, respectively. However, chronic symptoms responded less favorably after a median clinical follow-up of 26 months.

CONCLUSIONS

The strategy of predominantly endoscopic treatment with navigation planning is efficient to alleviate clinical symptoms and to significantly reduce the mass effect of pediatric intracranial cysts at different anatomical locations. The subgroup of infants requires close pre- and postoperative monitoring.

ABBREVIATIONS AC = arachnoid cyst; CAC = convexity AC; CVC = cystoventricular catheter; IHAC = interhemispheric AC; IVAC = intra- and paraventricular AC; MLC = midline cyst; PFAC = posterior fossa AC; SFAC = sylvian fissure AC; SSAC = suprasellar AC; TMAC = temporomesial AC; VP = ventriculoperitoneal.

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Contributor Notes

Correspondence Ulrich-Wilhelm Thomale: Charité-Universitätsmedizin Berlin, Germany. uthomale@charite.de.

INCLUDE WHEN CITING Published online April 30, 2021; DOI: 10.3171/2020.10.PEDS20839.

Disclosures Dr. Thomale: consultant for Scopis; honoraria from B. Braun and Aesculap.

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